Data Management and Health Care Technology Flashcards
Describe some less commonly used peripherals.
Some less commonly used peripherals include:
Light pen: A light pen can highlight information and send data to the computer by touching a specially designed monitor that recognizes the pen.
Touch screens: Touch screens allow the user to physically tap the screen with their finger or a plastic pen device in order to make choices.
Optical character recognition (OCR): OCR allows data to be read by a special device directly from the source. This technology is used in grocery store checkouts and standardized test grading. A similar form of input reader is the magnetic-ink character recognition (MICR). Banks use MICR to read the routing and account numbers of checks.
Computer enhanced imaging: Computer enhanced imaging is of particular importance to the medical field. Two examples include CAT scans (computerized axial tomography) and MRI (magnetic resonance imaging).
Discuss generating reports to identify trends and respond to quality measures: Control chart.
The control chart is similar to the run chart, but it has a mean line (the average of the data points) as well as upper and lower control limit lines, based on normal distribution. With any process, there is some normal variation (common cause or random variation) so the line values may vary; however, when the line crosses the control limits, this suggests that there is a specific cause (special cause variation) that requires investigation. The control limits are usually set at 2-3 standard deviations from the mean. Thus, the line shows the normal variations and excessive variations. The control chart can include horizontal lines, indicating each standard deviation for more precise information, dividing the graph into zones. Zone C is 1 standard deviation from the mean; zone B is 2 standard deviations from the mean; and zone A is 3 standard deviations from the mean. Positive values are above the mean line, and negative values are below. The data can be analyzed for specific trending, depending on the number of data points in each zone.
Explain the things that can go wrong with disaster recovery planning.
Many things can go wrong with a disaster recovery plan after a disaster. Unfortunately, many organizations fail to provide adequate support for operating under extreme situations. Some common areas that are sometimes found to be deficient include:
- Documentation: Critical documents should be stored in several locations (both digitally and in paper format).
- Equipment: As new equipment is purchased, it needs to be added to the plan.
- Data storage: Design the plan to allow quick recovery of critical information without needing to open an archive (or recover a database).
- Keeping the plan updated: Failing to keep the plan updated and failing to test the plan are two very common errors. Plans should be updated frequently and tested after each update
Define the term: electronic health record (EHR) and discuss its related guidelines.
The Healthcare Information and Management Systems Society (HIMSS) define the electronic health record (EHR) as a “secure, real-time, point-of-care, patient-centric information resource for clinicians.” HIMSS has also published a series of guidelines for EHR known as the HIMSS Electronic Health Record Definitional Model. According to the model, the EHR should record and manage information for both the short- and long-term. The EHR should be the healthcare professional’s main resource when taking care of patients. Evidence-based care can be planned using the EHR on both the individual and community level. Another important job of the EHR is its use in continuous quality improvement, performance anagement, risk management, utilization review, and resource-planning. The EHR aids in the billing process as well. Finally, the EHR is a boon to evidence-based research, clinical research, and public health reporting. Since it is computerized, clinicians are assured that the EHR information is up to date and relevant for patients and research protocols.
Discuss data representation: Binary code.
Data representation can be verbal (e.g., spoken/written representations), analog (e.g., television, radio, telephone, recorded), or digital (e.g., coded). Analog representation uses continuous waveform signals varying in intensity. Computerized representation of data uses codes (usually numeric), such as the binary code (base 2) to represent values. The binary code is comprised of strings of 1s and 0s with Is stored in magnetized areas of disks and 0s stored in nonmagnetized areas; thus, 1 represents “on,” and 0 represents “off.” Each representation (0 or 1) is referred to as a bit (binary digit). Data are converted into bits for digital transmission:
- 8 bits = 1 byte (can represent 256 characters).
- 1,000 b5d:es = 1 kilob)d:e.
- 1 million bytes = 1 megabyte.
- 1 billion bytes = 1 gigabyte.
- 1 trillion bytes = 1 terab5d:e.
The coding scheme is the pattern of 0s and 1s used to represent characters. For coding of English and European languages, the most common binary coding scheme is that of the American Standard Code for Information Interchange.
Describe read only memory (ROM) and random access memory (RAM).
Read only memory (ROM) and random access memory (RAM) are the two types of memory accessed in a computer. Read only memory (ROM) is a permanent type of memory that is preprogrammed and never written to (or replaced) by computer instructions. The advantage of ROM is that it cannot be changed (or erased) and will not be lost when the computer is turned off. Programming that is necessary for start up and other functions (such as those that must occur repeatedly and quickly) are generally stored in ROM.
Random access memory (RAM) is the computer’s working memory used for data storage. RAM stores the application programs that allow user controlled tasks to be carried out by the CPU. RAM may be stored on computer chips, the computer’s hard drive, floppy disks, or CD/DVDs (or any combination thereof). RAM is what most users think of when they store information on a computer.
Explain data presentation: Dashboard.
A dashboard (also called a digital dashboard), like the dashboard in a car, is an easy-to-read computer program that integrates a variety of performance measures or key indicators into one display (usually with graphs or charts) to provide an overview of an organization. It can include data regarding patient satisfaction, infection rates, financial status, or any other measurement that is important to assess performance. The dashboard provides a running picture of the status of a department or organization at any point in time and may be updated as needed—daily, weekly, or monthly. An organization-wide dashboard provides numerous benefits:
- Broad involvement of all departments
- A consistent and easy to understand visual representation of data
- Identification of negative findings or trends so that they can be corrected
- Availability of detailed reports
- Effective measurements that demonstrate the degree of efficiency
- Assistance with making informed decisions
Describe the three major parts of a data warehouse and the storage of data.
There are three major parts of a data warehouse:
- Infrastructure: The infrastructure (sometimes referred to as the technology perspective] refers to the hardware and software used in the system.
- Data: Data are diagram representations of the structures that send and store information and how they relate to one another.
- Process: Process is defined by how information gets from one place to another or how it is dealt with.
Most data warehouses use the Codd rules of normalization, which breaks data down into a table in order to show the relationships between the various parts. Two widely used designs are:
- Dimensional: The dimensional approach breaks data down into numerical facts and reference information. Dimensionally based databases are easy to use and operate quickly. However, their structures are difficult to modify.
- Normalized: The normalized approach saves information in the “third normal form” and groups the information into tables according to their subjects. These databases can be slow and difficult to use.
Describe the terms: decision support systems, expert systems, artificial intelligence systems, and natural language systems.
Healthcare facilities may utilize a number of different systems:
- Decision Support Systems
- Help people make judgments.
- Take all available data for a problem, generate results, implement the results in a simulation, and choose the optimum solution.
- Often used to make staffing decisions.
- Expert Systems
- Similar to decision support systems, but using logic derived from specific task experts.
- Operate using “If, then” type logic drawing from a database of knowledge in the problem area.
- Artificial Intelligence Systems
- Work using a model of human reasoning processes.
- Use the rules of inference such as “If A>B and B>C, then A must be greater than C.”
- Attempt to find new ways to represent abstract ideas.
- Actually learn by trial and error.
- Natural Language Systems
- Understand and process information in human language rather than programming language.
- Enable speech and handwriting recognition.
Discuss types of data: Qualitative, quantitative, primary, and secondary data.
Both qualitative and quantitative data are used for analysis, but the focus is quite different:
Qualitative data—Data are described verbally or graphically, and the results are subjective, depending on observers to provide information. Interviews may be used as a tool to gather information, and the researcher’s interpretation of data is important Gathering these data can be time-intensive and usually cannot be generalized to a large population. This information gathering is often useful at the beginning of the design process for data collection.
Quantitative data—Data are described in terms of numbers within a statistical format. This information gathering is done after the design of data collection is outlined, usually in later stages. Tools may include surveys, questionnaires, or other methods of obtaining numerical data. The researcher’s role is objective.
Primary data—Original data are collected for a particular purpose.
Secondary data—Data were originally collected for another purpose.
Discuss telecommunications: Radio-frequency identification.
Radio-frequency identification (RFID) is an automatic system for identification that employs embedded digital memory chips with unique codes to track patients, medical devices, medications, and staff. A chip can carry multiple types of data, such as expiration dates, patient’s allergies, and blood types. A chip/tag may, for example, be embedded in the identification bracelet of the patient, and all medications for the patient are tagged with the same chip. Chips have the ability to both read and write data, so they are more flexible than bar coding. The data on the chips can be read by sensors from a distance or through materials, such as clothes, although tags do not apply or read well on metal or in fluids. There are two types of RFID:
- Active: Continuous signals are transmitted between the chips and sensors.
- Passive: Signals are transmitted when in proximity to a sensor.
Thus, a passive system may be adequate for administration of medications, but an active system would be needed to track movements of staff, equipment, or patients.
Describe the three major classes of computers.
There are three major classes of computers:
- Analog: Analog computers measure specific continuous data and do not break the information down any further, They may measure temperature, pressure, heart rate, voltage, or current, The fetal monitor is one example of an analog computer used by nurses.
- Digital: Digital computers use binary code to represent datal This is the most common type of computer used at home and in businesses, Networked computers also communicate using binary code.
- Hybrid: Hybrid computers have elements of both analog and digital computersa These computers are produced and used for highly specific tasks which are often based on physics and engineering, The ECG and EEG are two Wpes of hybrid computers, They take analog inputs (brain waves in the case of the EEG) and transcribe them into binary data so that they can be studied and compared using a digital computer,
Outline the three classification systems used in nursing informatics: NANDA-I, Nursing Interventions Classification, and Nursing Outcomes Classification systems.
Outlined below are three classification systems used in nursing informatics:
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NANDA-I (North American Diagnosis Association-International)
- There are 167 classified diagnoses defined and characterized in this system.
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Nursing Interventions Classification (NIC)
- There are 514 treatments performed by nurses.
- System also provides links to NANDA diagnoses.
- System is categorized by 44 specialty practice areas.
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Nursing Outcomes Classification (NOC)
- Provides expected outcomes for patients, caregivers, family members, and community members for 330 disease states.
- System includes definitions, indicators, measurement tools, and references.
Using these in designing information systems ensures that terms and conditions follow established standards that can be compared across a wide swath of healthcare organizations. Consistent information is also helpful when publishing results.
Discuss the personal health records: Patient use.
The personal health record (PHR) presents an opportunity for patient use, allowing patients to participate in their own health care in a number of ways:
- Data entry: Most PHRs allow patients to enter some types of data, although this varies. A typical data entry includes personal and family health history, use of complementary therapy, and health behaviors (e.g., diet, exercise). Some also allow entry of health data, such as blood pressure readings, daily blood sugar, and weight.
- Delegation: PHRs usually allow the patient to assign a delegate or proxy (e.g., caregiver, immediate family member) to access the PHR. In most systems, parents can access information for a child until age 13; the child may assign a parent as proxy after that age, although selected information (e.g., sexual history, treatment) may be blocked.
- Messaging: Many systems allow patients to send secure messages to health care providers, in some cases routing them through a triage team.
Define the terms architecture and topology as they apply to computers.
The terms architecture and topology are defined as follows:
- Architecture: In the field of informatics, architecture is defined by the type of computer system used. Network architecture is the form of communication used between the computers involved. Broadcast communication, typically used in local area networks (LANs), involves sending the same data to every computer in the network. For example, a connection to the Internet consists of point-to-point communication where one computer sends information to only the specified computer.
- Topology: The way that computers are interconnected in a LAN is known as topology. When computers are connected to the network by a direct line, this is called bus topology. Star topology relies on a central computer (called a server) to relay information to each separate computer. Early local area networks were built on a ring topology (all computers were directly connected with one another).
Explain data presentation: Scattergram
A scattergram is a graphic display of the relationship between two variables with one variable plotted on the x axis and the other on the y axis. For example, the x axis may indicate age, and the y axis, admission to the emergency department. A data point is then entered for each admission, correlating with age. Analysis of the scattergram would then indicate the most common age distributions of patients. The scattergram can be used to test for possible cause-effect relationships, although this type of relationship is not required, and the scattergram is not proof of a correlation between data. As the data are plotted, repeat values are circled. With enough input, the data may begin to form a pattern. If this pattern is a straight line, there is evidence that there is a correlation between the two variables.
Describe the two primary data entry systems used in healthcare informatics: Clinical Care Classification system and the Omaha System.
Outlined below is the Clinical Care Classification system and the Omaha System used for data entry in the medical field:
Clinical Care Classification (CCC):
- This system was formerly known as Home Health Care Classification (HHCC).
- The system uses two major subsets of information:
- Diagnoses and outcomes: The terms used in the specific diagnosis and outcomes of a disease state.
- Interventions and actions: For a given disease state, the appropriate interventions and actions.
- There are 21 “Care Components” which classify care over a wide range of factors such as functional, physiological, and psychological.
Omaha System:
- Uses a Problem Classification Scheme (assessment). This scheme allows for evaluating the condition of the patient.
- Intervention Scheme. The intervention scheme prescribes the appropriate interventions to treat the problem (or disease state).
- Problem Rating Scale for Outcomes (in terms of knowledge, behavior, and status). The scale ranges from 1 to 5 (a Likert type scale)
Outline the primary patient benefits of using telehealth for healthcare needs.
There are many patient benefits associated with the use of telehealth. Several are outlined below:
- The patient does not have to travel to seek the advice of specialists who may be located many miles away.
- Electronic healthcare records can be accessed anywhere and at anytime. This access must be balanced with the privacy needs of individual patients and regulations (e.g., HIPAA).
- The patient becomes an active member in his or her own healthcare.
- Healthcare professionals from many different disciplines are able to collaborate and decide on the most appropriate course of action for the patient.
- Patients and family members have access to educational materials that are useful in helping the patient manage their condition.
- More patients have access to a specialist.
- Reduces or eliminates the cost of travel and thereby lowers the overall cost of healthcare.
- Digital records are easily accessible by healthcare providers.
Explain data presentation: Charts and graphs, such as line graphs, bar graphs, and pie charts.
Presenting data in the form of charts and graphs provides a visual representation of the data that is easy to comprehend. There are basically three types of graphs: line graphs, bar graphs, and pie charts.
- Line graphs have an x andy axis; they are used to show how an independent variable affects a dependent variable. A line graph can be used to show the number of infections that occur each week, month, or year.
- Bar graphs are used to compare the relationship between two or more groups. The graphs can show quantifiable data as bars that extend horizontally, vertically, or stacked. Bar graphs can be used to show comparison data of different populations or data from one time period to another.
- Pie charts are used to show the percentage of an item as compared to the whole. A pie chart can show, for example, the distribution of infection-control resources.
Define the terms: bits and bytes.
Computers use binary code to store data. Binary code has only two conditions: zero (off) and one (on). This is because early computers used physical relay switches with an on or off switch. A bit (binary digit) is defined as a single symbol of the binary code (its value equals zero or one). These bits are arranged into an eight-symbol unit (called a byte) to code meaningful information such as letters of the alphabet or numbers. From a series of eight bits, 255 different combinations of bytes can be formed. The cost of computer memory has come down in recent years and most home computers come with a minimum of 512 mega-bytes (MB) of main (active) memory, and a hard drive that can store 60 gigabytes (GB) of data.
Discuss data representation: Unicode standard coding scheme.
The Unicode standard coding scheme, used with the Universal Character Set, is a standardized coding system that has a large capacity and can be used to represent text for most languages, including Asian languages. Coding is available to represent technical characters, punctuation, and mathematic symbols. Unicode provides a specific numeric value for each character and can be used across multiple platforms. Unicode comprises approximately 110,000 characters, representing all alphabets of the world languages, ideographic sets, symbols, and 100 scripts, and is particularly valuable for making coding accessible internationally. Unicode is used in many technologies and operating systems. Unicode is promoted and supported by the Unicode Consortium. Unicode also allows private codes so users can assign values as needed.
Discuss hardware technical specifications: Limitations.
Technical specifications or requirements are usually described in detail, including operational characteristics and limitations. Technical specifications may include operations, operating system, version, display requirements, software requirements, capacities, features, devices, connections, supported environments, and data sources. Understanding the limitations of hardware is necessary for installation and use. Limitations may relate to the equipment (e.g., an inability to do some functions, standards, nonpermitted devices, limited number of slave devices), requirements (e.g., operating system, software packages that must be installed, type of power supply, environmental temperature), system managers (e.g., support not provided if operating system or equipment is modified, types of reports that can and cannot be generated), and users (e.g., help function limited to specific criteria, limits in access, sequence of key strokes for specific actions).
Discuss the display of patient data for clinical decision-making.
The effective display of patient data for clinical decision-making requires that information be rapidly available with minimal cognitive effort. The decision tree is a common presentation with potential options, consequences, and expected outcomes. Other types of presentations include tables, various types of graphs, and icons. In most cases, multiple modes of data presentation provide the best information. For example, if a health care provider wants to know a patient’s trend in blood sugars, a line graph is effective; however, if the provider wants the exact numbers to determine insulin dosage, getting this information is easier from a table. Patient data should be integrated in a meaningful manner. For example, a change in heparin dosage should automatically display the latest prothrombin time/international normalized ratio for the patient. Visual indicators, such as different colors, may be used to highlight information, such as abnormal laboratory results. Pictorial displays can be effective, but multiple displays on one screen are distracting and slow the cognitive processing of data.
Explain the National Institutes of Health (NIH) push for standards in information storage, creation, analysis, and retrieval.
The National Institutes of Health (NIH) is working toward implementing standards in the area of medical informatics. They recently began a push for standards in information storage, creation, analysis, and retrieval (ISCAR). Huge amounts of medical data are being created eveiy year. In order for this information to be compiled effectively, international standards are necessary. The creation of interoperational databases is essential. There is far too much information produced each year to fit into a single database. As an example, one research laboratory can produce enough information to fill one million encyclopedias in the course of one year’s work. In addition, key to this process is the importance of software that can analyze data taken from different databases. The rationale for this whole scheme is to allow for more comparative studies, make peer review simpler, and lend ease to verification of results.